HomeMy WebLinkAboutPermit Mechanical 2009-8-18
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Mechanical Permit Application
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I Date ~//F/ZJ 7 I
225 Fifth St"et . Sp,ingfield, OR 97477 . PH(541)726,3753 . FAX(541)726-3689
This permit isissued under OAR 918-440-0050, Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days, .
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1.0 Residential I 0 Government J 'M Commercial I,
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Job site address: 0ri"J f-\o...Ydel'\. 't\ Q f, ')0..'-1 I
I city:sfl rrlA<? Pi I' I d L State: 0 (C I ZIP: 11 ~ 77 I
Subdivision: \1 c::rn'L'3'b-=\ I Lot nY2.\oCO ~
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1 Name::5 Pr)--"'3 +-'-\'e iA \-a.,'~ Cei\.t fr
1 Address: '0.,O() ft<>.YdE'V\. ~\ t0~'" I
1 City: jp r-\',>q~le La- I State: oR, I ZIP: cj7q?8 I
1 Phone: 'I Fax: I
1 E-mail: I
This installation is being made on property owned by me or a
mem~er of my immediate family, and is exempt from licensing
requirements under ORS 701.010,
Signature:
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1 Business name: 'K,Pli\.t W~~\'V1 !/H. 1 LL ,I
1 Address: ,p 0 tBo ~ t7sg 1
1 City: ~ P"'l)g(Ji e [6 I State: OiR- I ZIP: '1'7477 1
IPhone:54-1 .5'13-lixsDI Fax: 1
1 E-mail: --1'\ 1J5:?./'\J'OC[ fi).. J-I o f-htfl. I' :t?ofY'\ 1
I CCB license no,: ''8StYCC 1
1 Print name: KZ:l--- W v:!-k.:I, rv1 1
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Signature: /., ~ /f( ~
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, 440,2545-1 (1l/08/COM)
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",ReSldentlal,::t,p~'"i1\,i!i,~4:'H"~h" ,Qtx,. .::"",_..ll:liiS iill1J;-_.;W,l!I
:t;-,(""'"""_;;'.'M>~,'1::-,'o.'''?lt'''-~1~Jt:&~,,~ 'c~"ki(l.)b:ii1li!",i;'r/:b":'~";l<f: .'/:;.,k'<L" "jix<ea:TiS~iti! ~cost:iJ'jp
First Appliance $79,00 $ I
!Furnace/burner ioclu'ding ducts and vents 1
1 Up to lOOk BTU/hr. I $17,00 I $ I
lOver lOOk BTUlhr, $20,00 $ I
I Heaters/stoves/vents I
I Unit heater $17,00 $ I
Wood/pellet/gas stovelflue $38,00 $ 1
Repair/alter/add to heating appliance! I
refrigeration unit or cooling system! $58,00 $
absorption system
I Evaponited cooler $13,00 $ I
I Ven! fan with one duct/appliance vent $9,00 $ I
I Hood with exhaust and duct $13.00 $ I
I Floor furnace including vent $58,00 $ I
I Gas piping I
lOne to four outlets I I $7,00 I $ I
I Additional outlets (each) $4,00 $ I
I Air"handling units, inclnding ducts I
1 Up to 10,000 CFM I I $11,00 I $ I
lOver 10,000 CFM $20,00 $ I
I Compressor/absorption svstem/heat pump I
I'up to 3 hp/JOOk BTU $17,00 $ 1
1 Up to 15 hp/500k BTU $29,00 $ 1
1 Up to 30 hp/J,OOO BTU $43,00 $, 1
1 Up to 50 hp/J,750 BTU $57,00 $ 1
lOver 50 hp/l,750 BTU $95,00 $ 1
I Incinerators I
I Domestic incinerator $20,00 I
Enter total valuation of ~ap.iq;' system I'
and installation costs $ ..:Ql~
Enter fee based on valuation of mechanical system, etc. $ I
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C1Mis~cellane(fuSffee's{a;ifllfi?:r!f~~~r;~lltems:' ,,~.9~J~ ,~gt'll_a~' , '
t';';1<;""':'l>N1>:11~2'.'W",,~,,~~&~~tv.,1d\\fi~li~~.\4<< ';a~", ' ,ea.~ ~cost"!;i.u: '.
1 Reinspection $58,00 $ 1
1 Specially requested inspections (per hr.) $58,00 $ ,I
1 Regulated equipment (unclassed) $13,00 1 $ ,I
I Each additional inspection: (1) 1 $58,001 $ I
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I (A) Enter subtotal of above fees (or enter set <t'il ') )r,j-
mlmmum fee of $ 79,00) $/;-p, JI
1 (B) Investigativefee (equal to [A]) $1
I (C)Enter'12%surcharge(,12x[A+B]) ,$1':: /) 1
I (D) Seismicfee, 1% (.01 x [A]) $ 1
I (E) Technology Fee (5% of[A]) $ (p j I 1
I TOTAL fees and surcharges (A through E): $ I 'i 1.l,
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Status
Iss u ed
CITY VI' I'lPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-0I203
ISSUED: 08/1812009
APPLIED: 08/18/2009
EXPIRES: 02/18/2010
VALUE: $ 8~153,OO
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 600 HAYDEN BRIDGE WAY
ASSESSOR'S PARCEL NO,: 1703233412600
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE: New
PROJECT DESCRIPTION: NEW GAS PACKAGED RTU WI ECONOMISER
Commercial
Owner: INTERNATIONAL CHURCH OF THE FOURSQU
Address: 600 HA YDEN BRIDGE WAY
SPRINGFIELD OR 97477 '
Contractor Type
Mechanical
- 'IOU to
I CONTRACTOR INEORM1i1'I0N'1 Uti\ity
:r\l::.trnU1'l, ~.. ted bY t\l" ~'-re ~et lorth
Contractor tlloW IUles ad~~!. \hOSE~!t~q!~\ 952Ex~\ration Date
KENT WITHAM AII~~,,\ilicatiO\l ?~~,[\01 0 thrcI8?,8~~ the !llles ? 03/13/2011
1.'BUIC'DINGCINF<:lRM'AiioNlle ~~~i\i~;t\~[\
vv....-. t\1e l..rO'''- 0\'\ Ul\II-'!
c#,^\\lf\'1Sqt . ,. '~e ore9 0332-2344),
0, ones:' , '-BO'
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HeightCorStructure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Phone
541-543.6580
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
A3
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
CE' uE'WOR\'fl.EQUlRED PARKING
NOTl, EXPIRE If Tn' ,
Oversla))Dist:\T S\iJl.LL ERMIT \S NOTrotal:
f'-'I ",,,.. TUIS P
# StreetrT.reeSlRqd:jDER n NED COR Handicapped:
^1I1\-j ''''L.' U .. NDO f
Paved Dr,ive(Rqd:OR IS Jl.BJI. Compact:
f"('"; ~ 111/\\.- ~\ ,t:iJ
%_of'Uot Coverage:'R\OD
{l,NY 180 DA~ no '
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I. Valuation Descriotion I
Description
Type of Construction
$Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
'I Fee,_ Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
JYIechanical- Value
Amount Paid
Date Paid
$15.15
$6,31
$126,25
Total Amount Paid
$147,71
I Plan Reviews I
8/18/09
8/18/09
8/18/09
U 1 i' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01203
ISSUED: 08/1812009
APPLIED: 08/1812009
EXPIRES: 02/1812010
VALUE: $ 8,153.00
R~ceipt N umher
2200900000000000930
2200900000000000930
2200900000000000930
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To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m, will be made the following
work day,
By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all
information hereon is true and correct, and I further certify that any and all work performed shall he dohe in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety,
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, alld the approved set of pia liS will remain 011 the site at all
times d~ring nstruc'n, ~
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I Refiluiredln~\l~~ti~n~ ~
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete,
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Owner or COli tractors SIgnature
Paee 2 of2
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Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1203
COM2009-01203
COM2009-01203
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Mechanical-Value
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
KENT WILLIAM AIR LLC
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City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000930
Date: 08/18/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
CJC 1091 In Person
Payment Total:
Page I of I
2:56:52PM
Amount Due
126,25
6,31
15,15
$147,71
Amount Paid:
$147,71
$147,71
8/1812009